BVA9502990 DOCKET NO. 92-19 080 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUE Entitlement to service connection for a thyroid disorder. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Nancy R. Kegerreis, Associate Counsel INTRODUCTION The veteran served on active duty from March 1944 to May 1946. This matter comes before the Board of Veterans' Appeals (Board) from a March 1992 rating decision by the Department of Veterans' Affairs (VA) Regional Office (RO) in San Francisco, California, which denied service connection for a thyroid disorder. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that, in the spring of 1944 while in the Navy, she suffered from low blood pressure and weight gain caused by a thyroid deficiency which resulted from a reaction to a typhoid shot administered upon entry into active service. She states that she was initially given "thyroid therapy" or was prescribed "thyroid tablets" for this disorder and that the initiation of this thyroid treatment in the service has resulted in a continued, lifelong dependence upon thyroid medication. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the appellant has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that her claim for service connection for a thyroid disorder is well grounded. Therefore, this claim must be dismissed. FINDINGS OF FACT 1. The veteran had an anaphylactic reaction to a typhoid inoculation given upon entrance into the Navy which completely resolved in less than two days. 2. No objective evidence as to a thyroid disorder in service or post service has been submitted, and there is no current evidence of a thyroid disorder. 3. There is no medical basis for the veteran's contention that an immunization for typhoid in 1944 could have contributed to a chronic thyroid condition. CONCLUSION OF LAW The veteran has not submitted evidence of a well-grounded claim for service connection for a thyroid disorder. 38 U.S.C.A. §§ 1110, 5107(a), 7105(d)(5) (West 1991); 38 C.F.R. § 3.303 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Background Service connection means, essentially, that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was contracted in line of duty coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.A. § 1110 (West 1991). Additionally, service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). Each disorder for which a veteran seeks service connection must be considered on the basis of evidence, including that shown by service records, medical records, and pertinent medical and lay evidence. 38 C.F.R. § 3.303 (a) (1994). The Court of Veterans' Appeals requires that the evidence supporting the claim be "plausible," that is, it must be meritorious on its own or capable of substantiation. See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). In this appeal, the Board finds that the veteran has not submitted a well grounded claim within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). This section of Title 38 unequivocally places an initial burden on a claimant to produce evidence that a claim is well grounded or plausible. See Grivois v. Brown, 6 Vet.App. 136, 139 (1994); Grottveit v. Brown, 5 Vet.App. 91, 91 (1993); Tirpak v. Derwinski, 2 Vet.App. 609, 610-11 (1992). Absent a well-grounded claim, the Board has no duty to assist, and the claim must be dismissed. See 38 U.S.C.A. § 7105(d)(5); Boeck v. Brown, 6 Vet.App. 14, 17 (1993). A report of physical examination upon the veteran's entry into service in March 1944 noted that she had had thyroid and pituitary treatment from November 1943 to January 1944. Under a section referring to recent gain or loss in weight, amount and cause, the examiner stated that the veteran had had a loss of 27 pounds in six weeks due to diet and to pituitary and thyroid medications. Also in March 1944 service medical records reveal that she was admitted to an infirmary about eight hours after her first typhoid inoculation, complaining of a severe headache and a swollen and painful arm at the site of the inoculation. Her temperature was 102.2 degrees and her pulse rate was 94. A physical examination was normal. The diagnosis was anaphylaxis due to a typhoid inoculation. A day or so later the veteran was deemed to be well and was returned to duty. A report of physical examination in December 1945 noted a medical history of illness due to anaphylaxis from March 22-24, 1944. It was also reported that she had had a recent weight loss of 10 pounds in six months. No other references to anaphylaxis appear in the service medical records. There is no evidence whatsoever of treatment for a thyroid disorder in service. Post service medical records provide almost no references to a thyroid disorder. In March 1986, VA outpatient clinical records reported a visit for a nasal deformity. At that time, she reported that she was taking no medications, except occasionally aspirin for neck pain. She had had a hysterectomy for suspected cancer in February 1985, performed by a Dr. James Popper, who had found no evidence of disease. In April 1990, the veteran was seen at the Palo Alto VA Medical Center endocrine clinic. Her reported history revealed that she had been on thyroid replacement for 46 years, presumably for "low blood pressure" and that she was still taking thyroid. Physical examination showed a thyroid that was small in size. The assessment was question of hypothyroidism. The examiner noted that the veteran's recollection of symptoms at the time of diagnosis suggest that she may not have had hypothyroidism. However, 46 years of exogenous thyroxine might have suppressed the thyroid so that it might not respond to withdrawal of thyroid treatment. A change in drug therapy was suggested to prevent over-treatment. An outpatient treatment record dated in May 1990 revealed that the veteran's thyroid medication had been changed in order to decrease the long-term risk of osteoporosis. Since the change in medication, the veteran complained of feeling tired and cold, falling asleep spontaneously, having a ravenous appetite, and a five-pound weight loss. An examination showed that she was clinically hypothyroid, probably due to years of being over- treated. Although the veteran has been treated at the Palo Alto VA Medical Center for other conditions, there is no other reference to specific treatment for a thyroid disorder. In a letter to the RO, dated in August 1992, the veteran stated that she had not been on thyroid therapy prior to entering the service and that "if such a statement appears in my records. . . it must have been conjecture of the examining physician due to my overweight." She wrote that in May 1944 her problem was deemed to be low blood pressure, not overweight, and that the accepted treatment for that condition at that time was thyroid therapy; every physician that she had consulted since service had recommended continuing thyroid therapy and "very serious problems" could result from discontinuing such treatment. In a November 1993 letter to the RO, the veteran stated that she had had continuous thyroid therapy from 1944 to the present. She reportedly had been treated at the Palo Alto VA since 1985 or 1986. About three years previously, her doctors had been concerned that such a high dosage would cause bone density problems. She reported that bone density proved normal, but a recent test showed a definite thyroid problem. She stated that all of her doctors had recommended that she continue on thyroid therapy. Unfortunately, all of them whose names she could remember had died, except for Dr. James Poppy, who had retired to an unknown address in the Middle West. In response to a VA remand, the Chief of Endocrinology at the Palo Alto VA Medical Center was requested to review this case and to provide an opinion as to the following questions: (1) whether there was any established relationship between the development of the veteran's thyroid disorder and the reported hypersensitivity to a typhoid injection; (2) whether a chronic thyroid disorder could be caused by a large dosage of thyroid medication; and (3) whether thyroid therapy, specifically iodine, was at any time an accepted treatment for low blood pressure. In answer to this request, this physician reported that he had reviewed the claims file and had searched the relevant literature concerning the above issues. Relative to the first question, he stated that in his opinion, there was no basis for any relationship between an immunization for typhoid and the development of thyroid disease. Although available literature indicated that acute typhoid infections could cause alterations in thyroid function tests, these abnormalities are similar to those observed with any acute febrile illness. Additionally, the thyroid abnormalities associated with these acute illnesses resolve following the illness and do not contribute to chronic abnormalities of the thyroid. He concluded that he could find no basis for the contention that an immunization for typhoid in 1944 could contribute to a thyroid condition in the ensuing 50 years. As to the second question, he related that, in the absence of intrinsic thyroid disease, taking thyroid medication will suppress normal thyroid function. In this instance, normal thyroid function will return after stopping the thyroid medication; however, it is possible for the patient to have symptoms consistent with hypothyroidism for a brief time, if over-medicated. Thus, it may take the patient's pituitary- thyroid axis several weeks before returning to normal. In addition, if the patient has acclimated to being mildly hyperthyroid because of over-medication for years, the return to a normal state upon cessation of thyroid medication will feel hypothyroid by comparison. He stated that taking large doses of thyroid medication will not cause a chronic thyroid condition to develop. Nonetheless, taking large doses of thyroid medication for a protracted period of time can cause some abnormalities, most notably bone loss or osteoporosis. The physician noted that the veteran had complained of symptoms consistent with hypothyroidism when the dose of her thyroid medication was changed in 1990, even though the laboratory tests at that time showed her to be normal on the lower dose. She also apparently had not developed bone loss, since her bone mineral density was reported to be normal for her age. In response to the third question, the physician stated that iodine is not currently an acceptable treatment for low blood pressure. Medical texts from the first half of the 20th century showed some references to the use of iodine by some physicians to treat high blood pressure, but no reference to the use of iodine for the treatment of low blood pressure. He noted that the veteran's blood pressure on her entry examination into the service showed a normal blood pressure. II. Analysis In reviewing the evidence, the Board finds that the veteran has not presented a plausible claim for service connection for a thyroid disorder. Referring to her contention that a typhoid inoculation caused a thyroid disorder, the Board points out that the adverse reaction to the typhoid injection apparently lasted only a day or so and then completely resolved without incident. Moreover, the VA physician consultant, after thoroughly reviewing the claims file, could find no medical basis for this contention. Since there is no medical evidence of record establishing a thyroid disorder, either in service or post service, the veteran cannot possibly establish an etiological relationship between the typhoid injection and a thyroid disorder. See Montgomery v. Brown, 4 Vet.App. 343, 346 (1993). Although it appears from the record and from the veteran's statements that she has been taking thyroid medications for many years, the medical records contain no evidence of a diagnosis of any type of thyroid disorder and no indication that the reduction in the dosage of thyroid medication caused more than a temporary hypothyroidism. The VA physician has noted that the veteran has had no untoward lasting reactions to large dosages of thyroid medication for an extended period of time. Moreover, the VA has given the veteran every opportunity to provide additional evidence to support her contentions, but she has been unable to do so. Therefore, the Board finds that this claim is not plausible or meritorious and that it must be dismissed. ORDER The claim of entitlement to service connection for a thyroid disorder is dismissed. WARREN W. RICE, JR. Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.